Access to Pharmacotherapy Amongst Women with Bipolar Disorder during Pregnancy: a Preliminary Study
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Bipolar disorder among pregnant women has deleterious effects on birth and child outcomes and is currently under-detected, not addressed effectively, or exacerbated through inappropriate treatment. The goal of this study was to identify perspectives of pregnant and postpartum women with bipolar disorder on barriers and facilitators to psychiatric treatment during pregnancy. In-depth interviews were conducted with pregnant and postpartum women who scored ≥ 10 on the Edinburgh Postnatal Depression Scale and met DSM-IV criteria for bipolar disorder I, II or not otherwise specified using the Mini International Neuropsychiatric Interview version 5.0. Interviews were transcribed, and resulting data were analyzed using a grounded theory approach to identify barriers and facilitators to bipolar disorder treatment access in pregnancy. Participant identified barriers included perception that psychiatric providers lack training and experience in the treatment of psychiatric illness during pregnancy, are reluctant to treat bipolar disorder among pregnant women, and believe that pharmacotherapy is not needed for psychiatric illness during pregnancy. Facilitators included participants’ perception that providers’ acknowledge risks associated with untreated or undertreated psychiatric illness during pregnancy and provide psycho-education about the risks, benefits and alternatives to pharmacotherapy. Psychiatric providers are critically important to the treatment of bipolar disorder and need knowledge and skills necessary to provide care during the perinatal period. Advancing psychiatric providers' knowledge/skills may improve access to pharmacotherapy for pregnant women with bipolar disorder.
KeywordsBipolar disorder Perinatal Pregnancy Postpartum Medications Treatment
Compliance with Ethical Standards
This work was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), [Grant numbers KL2TR000160, UL1TR000161]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Conflict of Interest
The first, third, fourth and seventh author have received salary and/or funding support from Massachusetts Department of Mental Health via the Massachusetts Child Psychiatry Access Program for Moms (MCPAP for Moms). The first author is also the statewide Medical Director of MCPAP for Moms. The first author has served on the Perinatal Depression Advisory Board for the Janssen Disease Interception Accelerator Program and the Physician and PPD Summit Advisory Board for Sage Therapeutics. The third author is the Lead Obstetric Liaison for MCPAP for Moms and has served on the Physician and PPD Summit Advisory Board for Sage Therapeutics, the fourth author has been the Program Director of MCPAP for Moms, and the eight author has served as a Consultant for MCPAP for Moms. The second, fifth, sixth and seventh authors declare that they do not have not conflicts of interest.
Research Involving Human Participants
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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